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Joan Blackwood
Clinical Lead MH Service Re-design
Frances Paton
Business Intelligence Manager (Partnerships)
Fiona McMahon Senior Practitioner,
Re-admissions/Service Improvement
Background
• 2010/2011 GG&C Performance and Development Plan – Contribution to Acute Services Framework (HEAT 10)
• GG&C A&E Attendances Steering Group• GG&C MH and A&E Acute Interface Working Group
(Lead - Calum MacLeod Head of Mental Health South Glasgow)
MH and A&E Acute Interface Working Group
• Multi disciplinary and management representation from A&E, Mental Health, Addictions, A&E Attendances Group, Homelessness, Liaison, Information Services etc.4 hour breaches + reasonsRepeat attendancesClinical PathwaysClinical Sub Group
• Wait for 1st Assessment
• Wait for Specialist Assessment
• Wait for Psychiatric Bed
• Wait for Transport
Areas that need to be explored - those with common causes for delay
Information
Greater Glasgow & Clyde – Phase 1
• Identify patients who are A&E Breachers
• Identify all A&E attendances who have a MH diagnosis and are known to our services.
• Extracted all Mental Health A&E presentations. (North & South A&E – not Clyde)
• Extracted all MH data recorded on PIMS (Inpatient, CMHT, Crisis etc).
• Resulted in ‘draft’ suite of information reports linking in with Service use .
To do this we -
• Merged into one database to identify patients. (Patient Linkage)
Snapshot of Information Reports (Period: 01/10/2009 – 31/03/2010)
• Better use of information to help inform decision making.
Last known MH Service prior to A&E presentation
Diagnosis category Count %
Alcohol 1,880 42%
Drug 1,240 27%
Psychiatric / Other 1,086 24%
Self harm (no drug / alcohol) 313 7%
Total: 4,519
Presentations where A&E Diagnosis is Categorised
Known to Mental Health Services Known to Adult CMHT
Presentations % Patients % Presentations % Patients %
3,880 61.6 2610 53.7 1,644 42% 1071 41%
7,057 MH presentations, CHI present in 6,296 (4,864 patients) so Reports are based on these 6,296 records
Last Known Service Prior to A&E Presentation Presentations
% of Total Known Prior to A&E Presentation
Inpatient 575 36%
CAT Team 402 25%
Adult CMHT 333 21%
Addictions Team 122 8%
Crisis Team 64 4%
Liaison Team 49 3%
Esteem 23 1%
PCMHT 20 1%
Homeless 11 1%
Other 7 0%
Elderly CMHT 4 0%
Total Known to Service Prior to A&E Presentation 1610 100%
Snapshot of Information Reports
• Better use of information to help inform decision making.
Associated CMHT’s for Patient
Unique % of Total % of Total Number of Patients with this amount of Presentations
Linked CMHT Patients Patients Presentations Presentations 1 2 3 4 5 6 7 8 9 10 12 14 16 22
Arran - Known 131 5% 196 5% 100 18 4 3 2 2 2
Arran – Not Known 278 11% 450 12% 194 45 19 4 10 4 1 1
Arran Total 409 16% 646 17% 294 63 23 7 12 6 2 1 1
Riverside - Known 160 6% 231 6% 119 23 9 6 3
Riverside - Not Known 147 6% 212 5% 125 11 4 2 2 1 1 1
Riverside Total 307 12% 443 11% 244 34 13 8 5 1 1 1
Springpark - Known 98 4% 178 5% 70 16 3 4 1 1 1 1 1
Springpark - Not Known 177 7% 252 6% 139 20 10 3 2 1 1 1
Springpark Total 275 11% 430 11% 209 36 13 7 3 2 1 2 1 1
Anvil - Known 93 4% 145 4% 68 11 8 4 1 1
Anvil - Not Known 145 6% 185 5% 115 25 2 2 1
Anvil Total 238 9% 330 9% 183 36 10 6 2 1
Shawpark - Known 93 4% 157 4% 68 14 3 3 2 1 1 1
Shawpark - Not Known 138 5% 229 6% 99 22 8 3 1 1 3 1
Shawpark Total 231 9% 386 10% 167 36 11 6 3 2 3 1 1 1
CLINICAL PORTAL
• What is Clinical Portal?
• Mental Health data on Clinical Portal
• Mental Health Sparra on Clinical Portal
A web-based system that presents all electronic information for a patient in a single location
The Portal uses technology to provide a clinician-friendly view of information from multiple information sources.
Data items to be published in the Mental Health clinical Portal are:o Alertso Open Referralso Diagnoseso Last Contacto Last Clinic Attendance
Predictive algorithm, developed by ISD. It identifies patients aged 15 years and over at risk of re-admission to a psychiatric hospital or unit.
Next Steps
• ‘Work in Progress’
• Consolidate and agree information requirements between services
• The initial information analysis has prompted questions about Clinical Pathways between A&E and Mental Health including Addictions
Mental Health, A&E & Addictions Patient Pathway
As a result of the data collection exercise reports can now bemade available to highlight :
• Patients who are known to both A&E and Mental Health Services
• Are regular attendees at A&E• Regularly breach the 4 hour target
But
• We needed to gain a better understanding of the patient journey.
• To identify gaps, blocks, delays, demand and capacity issues across services.
• Most importantly we wanted to know what was happening to patients.
• Sub-Group established included clinical staff from : A&E, Adult Community Mental Health, Crisis (day & night OOH) Liaison Psychiatry, Inpatients and Addictions
• Remit of Group: To carry out a process mapping exercise to accurately inform
routes into and out of A&E To test clinical scenarios across the process map and identify
current systems To support effective interface across all services
Mental Health, A&E & Addictions Patient Pathway
Process
• Three meetings – task and finish approach
• Plan – scope and range of the work
• Process map – involving all stake holders
• Follow up issues identified and action plan developed
Next Steps
• Feedback Progress – MH and A&E Acute Interface Working Group, GG&C Attendances Group
• Four dimensions to the action plan –– Clinical Practice– Information– Service Response– Patient Experience
• Extend membership of Clinical Group to reflect the further work required on pathways
• Information – Using information to help inform and improve clinical practice.
• Clinical Portal – A&E Staff will have access to Mental Health Service Data.
• Clinical Response – What is the expected response by A&E and Mental Health Staff.
• Develop Clinical Practice Guidelines – to access management/crisis plans, develop case review mechanisms.
• Service response – further work to be done with other parts of the Mental Health Service i.e. Addictions
Action Plan – “A Taster”